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The terrible aftermath of a once-lauded eye surgery

By Robert CribbJulian SherJennifer Quinn

Fri., April 12, 2013

Staring through eyes that could no longer focus, Dr. Brent Jesperson retreated into the darkness of his bedroom four years ago, away from his wife and two boys.

With the shades drawn, he lay in bed, pondering how to end his life.

In 1994, he had undergone a first-generation corrective eye procedure, one that thousands of other Canadians had during the 1980s and ‘90s. Afterwards, his vision became permanently hazy.

“I thought my life was over,” the 51-year-old says. “Imagine the stress of losing your business, your eyesight, your life. And you paid to have it done to you. It’s unimaginable.”

Jesperson has just filed a $12-million lawsuit against Dr. Yair Karas, the Toronto ophthalmologist who performed the now-obsolete procedure, called radial keratotomy or RK, on Jesperson.

The procedure involved making microscopic incisions in the eye radiating outwards from the centre. The slits were intended to correct nearsightedness by flattening the cornea and allowing light to better focus on the retina.

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Thousands of Canadians got RK to correct their myopia, many lured by aggressive ads promising freedom from contact lenses and eyeglasses. And many experienced improved vision from the once-innovative procedure, at least for a time.

But long-term complications are now an accepted legacy of RK.

The Star has reviewed thousands of pages of documents and interviewed more than a dozen RK patients, some whom refer to themselves as guinea pigs for an industry that placed profits over public health.

Jesperson and six other Karas patients interviewed by the Star say the procedure eventually made their vision, and their lives, dramatically worse. Two say they are also preparing to sue Karas.

A 2001 lawsuit by a former RK patient claiming negligence on the part of the ophthalmologist was settled out of court.

“It was a complete failure from Day 1,” says Daniel Twomey, who filed the lawsuit. “My eye is irreparable. I’m stuck.”

With dozens of lawsuits filed in the U.S. over the past two decades by RK patients claiming damaged eyes and lives, Jesperson’s lawsuit could be an early distant warning of a looming health-care tragedy in Canada involving an aging generation of RK patients.

When contacted this week about Jesperson’s allegations, which have not been proven in court, Karas said: “We will deal with this in the courtroom.”

But, also refusing to comment on the allegations of other former patients interviewed by the Star, 71-year-old Karas said he has “no regrets” about conducting 10,000 RK procedures during his 36-year career.

“I think it’s the best thing I’ve ever done. There’s 1,000 police officers in Toronto that got into the police because of what I did, there’s 50 pilots in Air Canada that are flying with my surgery — otherwise they wouldn’t get in — and there is at least 1,000 firefighters in Canada . . . clergymen, like bishops, judges in the Supreme Court, most of the important families in this country . . . Most of the doctors in the U.S. know my name.”

Last year, the Ontario College of Physicians and Surgeons dismissed a complaint Jesperson filed against Karas, ruling that while his vision problems are now recognized as a complication from RK, the procedure was accepted at the time, and he had signed a consent form acknowledging the risks.

The Star has obtained two other similar complaints against Karas from patients who also allege long-term vision damage from the procedure. The college responded identically when dismissing the complaints.

Karas’s public record remains clear on the college’s website. And the college does not make public details on any complaints or internal disciplinary actions against physicians that don’t reach a public disciplinary hearing.

In 2006, Karas signed an undertaking with the college to stop performing RK.

Each year, millions
of Canadians pour into private clinics for well-advertised eye surgeries, cosmetic procedures and fertility technologies such as IVF in which they undergo groundbreaking techniques with limited independent oversight.

So how do new medical breakthroughs enter into widespread use without independent review or government approval?

These patients “can be the canaries in the mine shaft,” says Dr. Martin McKneally, a long-time thoracic surgeon who is now a professor emeritus at the University of Toronto’s Joint Centre for Bioethics.

“It’s not fair to expose heroic people who say, ‘I want to be first to have this done’” — their consent or willingness is necessary, but insufficient, he says. “There also has to be assurance that what they are about to experience is reasonable and reasonably safe.”

Jesperson concedes he signed sign a consent form when he agreed to the procedure in 1994. But his statement of claim alleges the form didn’t spell out the risks, and that Karas “hid, omitted, or otherwise failed to disclose” them.

The statement alleges Karas adjusted the consent form “in an effort to promote the procedure and hide known risks.” Jesperson alleges the removal was intentional “and designed to increase sales of his services to the public and, in particular, to Dr. Jesperson.”

During the 1980s and 1990s, RK — costing between $1,200 and $1,800 per eye — was heavily marketed across North America by hundreds of ophthalmologists. “Throw away your glasses for good,” magazine ads and ophthalmology brochures proclaimed. “Live life with clear vision.”

But now, most experts agree the procedure is an example of what can happen when an experimental, unregulated, elective breakthrough goes wrong.

Dr. Edward Boshnick, a Miami optometrist who now specializes in treating RK patients, including Canadians, who suffer fading sight, says the procedure has left “a trail of disaster around the world.

“These were money-driven procedures. There’s no medical need for any of these procedures. This was all done on hokey advertisements, and false promises to have you throw away your glasses. It’s not true.”

RK was first devised in Japan during the 1930s, and in the 1970s was further developed by a Russian ophthalmologist named Dr. Svyatoslav Fyodorov. By the early 1980s, RK was being practised in North America with few standards.

While it was very popular — thousands of Canadians, and at least a million Americans, had it done — it has since fallen out of practice amid mounting concerns about long-term damage to vision caused by weakened corneas.

While Health Canada regulates medical devices, it does not oversee medical procedures. The provincial colleges of physicians and surgeons — mandated to regulate the practice of medicine in Canada — are reactive, taking action only after complaints or legal actions point to negligence, often long after the fact.

The economic burden of RK’s now-acknowledged failures is shifting to the public purse.

Health-care costs poured into treating Canadians whose vision was impaired by the procedure could represent millions. Since 2009 alone, Jesperson says, he has attended close to 100 appointments with doctors to deal with the RK aftermath.

“We’re offsetting the true costs of this onto the public system,” says Michael Munro, Jesperson’s lawyer.

RK patients interviewed by the Star — who talk about pain, depression and impaired vision — all say they weren’t warned that the procedure permanently weakened the cornea, although that information was presented in medical journals and ophthalmology publications at the time.

In Canada, Karas
was among RK’s most prolific practitioners. Former patients — even those who now say they have suffered debilitating long-term vision problems — describe him as a charming and personable physician.

“He was very supportive and accommodating,” says Marlene Kirby-Schugt, a Whitby psychotherapist who had RK with Karas in the late 1980s.

She now suffers blurry, fluctuating vision that glasses won’t fix.

“I always thought of him as a great person.”

And he came highly recommended.

Monika Wright, a Toronto real-estate agent, went to Karas’s clinic on the recommendation of a friend who sang his praises. In 1993, Gilbert Roy, a 25-year-old Sudbury steelworker tired of wearing thick, heavy glasses, sought out Karas for RK after reading a newspaper story.

Gene Costain had RK the same year after researching Karas and the procedure, and coming away convinced it was “solid.” In 1994, Denise Bosse, concerned about meeting the vision requirements to become a police officer, took the advice of a member of the OPP who had RK from Karas.

When patients stepped inside Karas’s Richmond Hill clinic, they were met with a persuasive display: hundreds of pairs of glasses left by former patients.

“I said, ‘Wow, this is just amazing,’ ” Roy recalls. “That sold me right there.”

RK was the first real medical solution for the nearsightedness that limited the vision of millions of North Americans. Newspaper and magazine advertising made bold promises.

In one early-’90s newspaper advertisement for the Karas Vision Centre — “Tired of Wearing Glasses or Contact Lenses?” — Karas claimed to have performed the “well-established” procedure more than 3,000 times on people from Canada, the U.S. and around the world.

“About 95 per cent of these patients no longer require glasses or contact lenses,” the ad reads.

Karas’s website, no longer online, promoted him as “one of the world’s leading eye surgeons,” who “brought the gift of sight to over 10,000 people.”

RK emerged as an economic pick-me-up for the ophthalmology profession.

On the cover of the February 1995 issue of Ophthalmology Times, a fistful of dollars emerged out of a giant eyeball with the headline: “RK: Don’t wait to grab on.”

The article said, “the basics can be learned in a weekend.”

A 1993 brochure pitching a $950 weekend course for ophthalmologists urged: “Don’t miss this chance to see how you can successfully diversify your practice and prosper through the ’90s.”

And in 1994 — the year the U.S. Federal Trade Commission began probing advertising claims related to RK based on “numerous inquiries concerning potentially misleading promotions” — Jesperson walked into Karas’s clinic to find out more about the surgery.

The Greater Toronto dentist had suffered from myopia his whole life. He found contact lenses uncomfortable and wanted to shelve his glasses for good. A classmate in dental school had given Karas positive reviews.

The ophthalmologist “convinced me it was safe. I liked him.”

On the day of the procedure, Jesperson’s wife, Irena, drove him to Karas’s clinic. The doctor made eight tiny incisions in each of Jesperson’s eyes.

It worked, for a short time.

Two years later, Jesperson was back at Karas’s office for a second series of incisions — a tune-up — and again, his vision improved.

Jesperson had his glasses mounted on a plaque and placed with the others on display at Karas’s clinic.

Though his vision had improved, it was never perfect. He returned for other procedures, including one in 1999 during which Karas crossed the previous incisions in a T-shape, he says.

“This was the straw that broke the camel’s back. It weakened my cornea again — the beginning of the end for my left eye.”

By the end of 2008, his vision was failing in his left eye, and pain and headaches from eye strain were making work difficult.

“I had no depth perception, and I work in 10ths of a millimetre on teeth — braces, implants, surgery, wisdom teeth,” he says. “I stopped doing the harder procedures and stuck with the easy ones to get through it.”

On July 2, 2009, Jesperson left his dental office for what he hoped would be a few weeks. He had an appointment with a corneal specialist to try to repair the damage to his eye.

He never returned to work.

Feeling as though he had failed himself, his patients, his family and his staff, Jesperson became despondent.

“During this time, I’m constantly fighting with thoughts of hurting myself,” he says. “I knew I was suffering from depression. But I didn’t know if I could live like that. These thoughts permeate your mind.”

Irena, his university sweetheart and wife of 29 years, feared for his life.

“He was lying in the dark in horrible pain and couldn’t see,” she recalls. “I couldn’t even leave the house to get groceries because I didn’t know if he’d be dead when I got home.”

Three decades after
RK’s emergence, the message about its effectiveness and safety from the ophthalmology community has changed dramatically.

“For (RK patients) treated aggressively . . . the legacy on those patients is pretty bad,” says Dr. Richard Abbott, an ophthalmologist at the University of California San Francisco.

“It was risky for doctors to be so aggressive. But every metropolitan area had their more aggressive surgeons who pushed the marketing envelope.”

Dr. Michael Easterbrook, a University of Toronto ophthalmologist who co-authored a landmark 1996 study raising concerns about weakened eyes from RK, says he and many of his Canadian colleagues were never willing to perform the procedure.

“Most ophthalmologists felt it was inherently unsafe,” he says. “It was an effective procedure but it was obvious to anyone that it was weakening the eye, and most of us looked and said, ‘You can’t do this.’ ”

For some Karas patients, such as former real-estate agent Monika Wright, vision declined gradually.

For others, what remains is lifelong trouble.

Gilbert Roy, the metal worker from near Sudbury, eventually had to quit working in dimly lit steel fabrication shops because he could not see well enough. “It was devastating,” he says.

Denise Bosse, now 41, had six procedures over a dozen years with Karas — four on her left eye and two on her right. She was left with more than 20 incisions in her eye — and a bill of nearly $5,000.

Today, her vision remains fuzzy, fluctuating throughout the day. So, she says, getting a prescription for glasses is impossible.

“He has ruined my vision,” Bosse says. “I would have never done this procedure if I would have known that this could happen.”

But not all of Karas’s former patients say RK was a failure.

Two decades after undergoing the procedure, former Toronto journalist Gene Costain says he hasn’t suffered any consequences to his eyes. But he remains cautious.

“I’ve been very lucky, but my luck has not been shared. It was horrifying to hear that some had different outcomes, so it’s always in the back of my mind.”

Today, there is a milky cloudiness in Jesperson’s left pupil.

To see for portions of the day, he wears an over-sized contact lens in his left eye called a scleral. It costs him $5,000 a year.

His trust in his physician and the regulatory system in place to protect patients was abused the moment the knife touched his cornea, he now declares.

“It was a human experiment. They all knew. But they didn’t stop it.”

Tomorrow
: Who looks out for the public good when a new procedure is introduced?

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